RN Care Coordinator

2 weeks ago


Harrisburg, Pennsylvania, United States Highmark Health Full time
Job Summary

This RN Care Coordinator role is responsible for coordinating care and managing the coordination of care in accordance with recognized standards of practice for Care Management. The incumbent will utilize expertise in care management to promote a collaborative professional environment that supports excellence of care and achievement of optimal resource utilization.

Key Responsibilities
  • Assumes role in assessment of patient physical, psychosocial, and economic needs for effective transition of care planning to a variety of levels of care.
  • In collaboration with the care team, facilitates the development and communication of the continuum of care transition plan to appropriate health service providers.
  • Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes.
  • Interviews and collects patient specified data and chart review related to readmission.
  • Knowledgeable of and complies with accreditation and regulatory requirements.
  • Integrates performance improvement principles and customer service principles into all aspects of job responsibilities.
  • Obtains or ensures acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines.
  • Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials.
  • Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc.
  • Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines.
Requirements
  • Required: Bachelor's Degree in Nursing or 6 years of related and progressive experience in lieu of Bachelor's degree.
  • Required: 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management experience.
  • Preferred: Discharge planning and community resource knowledge, Care facilitation and utilization review experience.
  • Required: RN license In appropriate state based on location and CPR Certification.
Skills
  • Motivational interviewing competency.
  • Advance care planning competency.
  • Ability to work in a high performing team environment that requires flexibility.
  • Excellent organizational and time management skills.
  • Competent computer skills including Microsoft Office products.
Travel Requirement

50% - 75%

Physical, Mental Demands and Working Conditions

Office-based, Teaches / trains others regularly, Occasionally travel from the office to various work sites or from site-to-site, Occasionally works primarily out-of-the office selling products/services (sales employees), Never physical work site required.


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